Mental Health Advance Directive (Declaration for Mental Health Treatment)

Plan Ahead for Your Mental Health Care

At Trellis Counseling, we believe it’s important to be prepared for how you’d like your care to go—especially if a time comes when you are unable to make decisions for yourself. The state of Oregon provides a form called the Declaration for Mental Health Treatment that allows you to outline your preferences and appoint someone to advocate for your mental health care when you can’t.

What is a Declaration for Mental Health Treatment?

This legal document lets you:

  • Specify the kinds of mental health treatment you would or would not want if you’re unable to make decisions.

  • Name an adult you trust to make decisions on your behalf (a proxy) if you’re unable.

  • Ensure your voice is heard and your wishes are respected.

Oregon’s official form is valid for three years; if you regain decision-making capacity, the directive ends. You can change or cancel it any time while you are capable of making your own decisions. Oregon+2OHA Shared Systems+2

How to Access the Form

You can download the official form from the Oregon Health Authority (OHA). OHA Shared Systems+2Oregon+2

  • English version: [Declaration for Mental Health Treatment – OHA]

  • Spanish and other language versions are also available on-site.

Direct link to form: https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/le9550.pdf

What You Should Do

  • Download and fill out the form when you are clear-headed and able to make decisions.

  • Make sure the person you appoint as your proxy knows they agree to act on your behalf.

  • Share a signed copy with:

    • Your mental health provider

    • The person you’ve appointed

    • A trusted friend or family member

  • Keep the original in a safe place and let people know where it is.

  • Review your directive periodically and update it if your wishes change.

Why This Matters

Without a directive, decisions about your mental health treatment may be made by others without knowing your preferences. By completing this document, you help ensure your values and choices guide your care—especially in times when you might not be able to speak for yourself.